Accreditation Council for Pharmacy Education (ACPE) Update for AACP Council of Deans ACPE Board of Directors and Executive Staff AACP Interim Meeting ▪ Savannah, Georgia February 28, 2011 ACPE Board and Staff Speakers • Heidi M. Anderson, PhD ACPE President (University of Kentucky) • Robert S. Beardsley, RPh, PhD ACPE Vice President (University of Maryland) • Michael A. Moné, RPh, JD, FAPhA ACPE Secretary/Treasurer (Cardinal Health) • Stephanie F. Gardner, PharmD, EdD ACPE Board of Directors (University of Arkansas) • Peter H. Vlasses, PharmD, DSc (Hon.), BCPS, FCCP ACPE Executive Director • Jeffrey W. Wadelin, PhD ACPE Associate Executive Director, and Director, Professional Degree Program Accreditation Purpose of Discussion • Part of ACPE’s ongoing effort to engage in a collaborative dialogue with stakeholders • Convey and clarify information on activities, policies and procedures • Respond to topics submitted by deans • Discuss opportunities to improve ACPE’s interactions with schools/colleges ACPE Communications Assessment October – December 2010 • • • • • Key Issues Identified Process vs. Outcomes Assessments Quality vs. Quantity Transparency Consistency in Accreditation Review Collaborative Approach Process vs. Outcomes Assessment: Feedback Received • Concerns about the evidence-base of some standards and guidelines • Accreditation requirements are resource intensive for colleges and schools • ACPE’s processes limit flexibility and innovation Process vs. Outcomes Assessment • Accreditation is outcomes focused; process and structure are linked to outcomes • ACPE is committed to assuring quality in all accredited pharmacy education programs • “What does ‘good’ look like” – collaborative effort of practice organizations, AACP, and ACPE “Accreditation is a trust-based, standards-based, evidenced-based, judgment-based, peer-based process.” —CHEA, 2009 ACPE Stakeholder Conference September 12–14, 2012 Atlanta, GA • Advancing Quality in Pharmacy Education: Charting Accreditation’s Future • Invitational consensus-seeking conference • In collaboration with a broad array of leaders in pharmacy, health care, and education leaders ACPE Stakeholder Conference Objectives • Examine competencies that are currently required of pharmacists and competencies that will be required in the future • Expand evidence-based practices in assessing the quality of educational programs • Inform standards, guidelines, and process quality improvement initiatives Dean-Submitted Question S2007 Guidelines 2.0 Please discuss the “effective date” and when schools will be held accountable for new guidelines during reviews. S2007 Guidelines 2.0 • Guidelines 2.0 are in effect – – – – Site teams will evaluate starting Fall 2011 cycle Provides clarification and/or quality improvement additions Reflects ACPE Board of Directors policy decisions 15 new “must” statements (many have previously been communicated) • AAMS will be updated by April 30, 2011 • Rubric v4.0 will be released by April 30 and will provide an overview of key changes – Effective on July 1 • Self-studies in progress that are using other versions of the rubric must address the changes in the text of their selfstudy submissions Dean-Submitted Questions Accreditation Timeframes • Will ACPE consider modifying the accreditation cycle by lengthening terms (e.g., to 7–8 years)? • Will ACPE consider reducing the number of reports by increasing time between interim reporting? ACPE Subcommittee to Analyze Accreditation Cycle and Process • Subcommittee will analyze accreditation cycle and process for colleges and schools of pharmacy • Comprised of 4 ACPE Board members, 2 deans (AACP-appointed), ACPE staff member • Preliminary report to ACPE Board – June 2011 Issues at the Intersection of Quality and Quantity: Feedback Received • Is ACPE adequately addressing quality in new schools and/or expanded programs? • Is quality within experiential education impacted? Adequate sites and preceptors? • Is quality of faculty and academic leadership diminished? Accredited PharmD Programs* Programs with Accreditation Status (n = 124) • Full Accreditation Status: 99 – Programs that have graduated students • Candidate Accreditation Status: 16 – Programs with students enrolled but have not yet produced graduates or have graduates and have not addressed all the accreditation standards • Pre-Candidate Accreditation Status: 9 – Programs that have not yet enrolled students or are in their first year of classes * Inclusive of January 2011 Board Actions Distance Campus Expansions • 26 programs have distance campuses* – 19 are public and 7 are private • 3 programs are in the process of being evaluated to open a distance campus • 5 programs have branch/distance campuses out of state (* Distance campus = delivery of didactic curriculum to/from site) Pharmacy School Graduation Trends 11,487 Number of Graduates 12000 10000 8000 6,956 6000 4000 2000 0 Source: AACP Fall 2010 Data and ACPE February 2011 Estimates Pharmacy school graduates 2011–2014 projected based on current enrollment and ACPE-estimated attrition 13,822 14000 Are new colleges and schools of pharmacy primarily responsible for this increase in pharmacy graduates since 2003? Increase in Pharmacy Graduates Since 2003 Source: AACP Fall 2010 Data and ACPE February 2011 Estimates Increase attributable to pre-1995 schools n = 118 Increase in No. of Graduates (from 2003 baseline) 7000 n = 114 Increase attributable to post-1995 schools n = 110 6000 n = 102 5000 4000 n = 98 n = total number of US colleges and schools with graduates n = 90 n = 93 n = 89 3000 n = 88 2000 n = 85 n = 83 1000 0 2004 2005 2006 2007 2008 (Actual numbers) 2009 2010 2011 2012 2013 (Projected numbers) 2014 Increase in Pharmacy Graduates Since 2003 Source: AACP Fall 2010 Data and ACPE February 2011 Estimates Increase attributable to pre-1995 schools n = 118 Increase in No. of Graduates (from 2003 baseline) 7000 n = 114 Increase attributable to post-1995 schools n = 110 6000 n = 102 5000 4000 n = 98 n = total number of US colleges and schools with graduates n = 90 n = 93 n = 89 3000 n = 88 2000 n = 85 n = 83 1000 0 2004 2005 2006 2007 2008 (Actual numbers) 2009 2010 2011 2012 2013 (Projected numbers) 2014 ACPE Monitoring of Pharmacy Programs – Quality and Resources • Comprehensive and focused accreditation reviews • Annual monitoring metrics (e.g., NAPLEX, enrollments, progression/graduation, dismissals, withdrawals, attrition) • AACP standardized surveys (e.g., graduating students, faculty, preceptors, and alumni) • Launch of Assessment and Accreditation Management System (AAMS) with AACP • Identification of noteworthy practices NAPLEX Passing Rate for First-Time Candidates 2004–2010 Passing Rate Pre-1995 versus Post-1995 Programs 100% 98% 96% 94% 92% 90% 88% 86% 84% 82% 80% 96.7% 7 Post-1995 Programs 97.0% 24 Post-1995 Programs 96.7% 95.6% 95.8% 93.0% 92.0% 95.1% 96.3% 96.5% 94.4% 94.1% 92.3% 85.9% 2004 2005 2006 2007 2008 2009 2010 Pre-1995 Programs Post-1995 Programs n= 23 40% n = 10 n = 12 50% 10% n=6 n=1 Post-1995 Programs n=2 20% n=1 Pre-1995 Programs n=3 30% n=1 Percentage of Programs 60% n= 39 2010 NAPLEX Passing Rate Spread for Pre-1995 versus Post-1995 Programs 0% 66 -70% 71 - 75% 76 - 80% 81 - 85% 86 - 90% 91 - 95% 96 100% 2010 Graduating Student Survey Results Section I: Professional Competencies/Outcomes (N = 7,496) ThePharmD PharmD Program preparedprepared me to: The Program me to: Communicate with patients and caregivers Communicate with patients and caregivers Gather and use specific information to identify patient medication-related Gather and use specific information to identify patient medication-related problemsproblems Develop a patient care plan to manage Develop a patient care plan to manage each medication-related each medication-related problem problem 54.5% 43.5% 54.4% 43.7% 50.0% 47.9% 1.7% 1.6% 1.9% Strongly Agree Agree Work with a health care team to implement the patient care Work with a health care team to implement the patient careplan plan Manage the system of medication use to affect patients Manage the system of medication use to affect patients Work with other stakeholders and resolve Work with other stakeholders to identify and resolve problems problems related to medication use related to medication use Disagree/Strongly 43.4% 37.4% 41.3% 51.5% 55.7% 55.0% 4.6% Disagree 4.4% 3.2% 2010 Graduating Student Survey Results Section III: Pharmacy Practice Experiences (N = 7,496) My introductory pharmacy practice experiences were valuable in helping to prepare me for my advanced pharmacy practice experiences My introductory pharmacy practice experiences permitted my involvement in direct patient care responsibilities in both community and institutional settings In the community pharmacy setting, I was able to apply my patient care skills 24.1% 48.5% 23.4% 47.5% 42.3% 21.4% 22.9% 47.8% 8.7% Strongly Agree In the ambulatory care setting, I was able to apply my patient care skills In the hospital or health-system pharmacy setting, I was able to apply my patient care skills 54.0% 39.6% 4.1% Agree Disagree/Strongly Disagree 43.4% 47.2% In the inpatient/acute care setting, I was able to apply my patient care skills 48.5% 45.2% Overall, my advanced practice experiences were valuable in helping me to achieve the professional competencies 46.9% 48.3% 8.3% 4.4% 4.0% 2010 Faculty and Preceptor Survey Curriculum Responses (Faculty N = 2,604 / Preceptor N = 8,170) The PharmD Program prepared students to: Develop and use patient-specific care plans Efficiently manage a patient-centered pharmacy practice Develop disease management programs Manage the system of medication use 96.3% 97.5% 93.9% 93.6% 91.1% 89.9% 94.5% 93.7% Promote the availability of health promotion and disease prevention initiatives Communicate with patients, caregivers, and other members of the interprofessional health care team Preceptor Strongly Agree/Agree 95.4% 94.4% 96.8% 97.2% Faculty Strongly Agree/Agree 2010 Faculty and Preceptor Survey Curriculum Responses (Faculty N = 2,604 / Preceptor N = 8,170) The PharmD Program prepared The Pharm.D. Program prepared students to: students to: Search the health sciences literature Search the health sciences literature 96.7% 94.1% 94.2% Evaluate the Evaluate the health sciences literature health sciences literature Demonstrate expertise in the area of Demonstrate expertise in the area of informatics informatics Apply state and federal laws and Apply state and federal laws and regulations to the practice of regulations to the practice of pharmacy pharmacy 90.6% Preceptor Strongly Agree/Agree 92.0% Faculty Strongly Agree/Agree 82.9% 96.6% 98.2% 97.9% Maintain professional competence Maintain professional competence 96.1% New School Process Required Evaluations & On-site Visits for ACPE Accreditation of New Programs Draft Application On-site Consultation (1 staff member) Paper review of draft application (team of 4) Evaluation for Precandidate Status (team of 4-5) Evaluation for Candidate Status (team of 4-5) Evaluation for Continuation of Candidate Status (team of 2-3) Over 7 years: a New Program is evaluated by 24–36 individuals Consideration of Full Status (team of 4-5) Evaluation for Continuation of Initial Full Status (team of 2-3) New School Process—Initial Contact to Possible Approval of On-Site School Actions ± 9 months ACPE Actions New School Process—Approval of On-site to Candidate Status School Actions 1 Year ACPE Actions 1 Year New School Process—Candidate to Initial Full Status School Actions 2 Years ACPE Actions 2 Years New School Process—Initial Full to Continuation of Full Accreditation School Actions 2 Years ACPE Actions 4 Years Site Team Composition • • • • • • Dean Pharmaceutical sciences Pharmacy practice Practitioner not affiliated with the school Staff member from ACPE Board or former Board member (based on availability) Individuals from curriculum and assessment committees and with experiential oversight are preferred 29 Point Threshold Rubric http://www.acpe-accredit.org/pdf/Threshold_Document.pdf Dean-Submitted Question Proportion of Aspiring Schools Accredited • What is the percentage of colleges and schools who have applied for precandidate status since 2000 and have achieved this status? Proportion of Aspiring Schools Accredited • Programs have investigated establishment of a pharmacy program with ACPE but approximately 10 did not pursue application • 40 programs were evaluated for preaccreditation – 3 programs were not authorized for a precandidate visit – 16 programs delayed at either precandidate, candidate, or full accreditation (or a combination of these) at some point in the process Dean-Submitted Questions Quality/Quantity of Clinical Sites • How will the shortage of quality experiential sites be addressed by ACPE for new and existing schools? • How will ACPE deal with schools that have “lost sites” to new programs? • Is ACPE considering some sort of public opportunity for comment on the "impact" of establishing a new school or is this just a rumor? APPE Preceptor Data (N=39 programs,* F2008–F2010) Source of Preceptors Program Reported % Full-time faculty Mean: 24% Range: (3 - 62%) Contract/volunteer faculty Mean: 76% Range: (38 - 97%) *Existing or new schools about to produce graduates APPE Preceptor Data (N=39 programs,* F2008–F2010) Total APPEs in Setting %Precepted by Full Time Faculty Community 5,094 2% 98% 0 – 1,299 (0 – 93%) Hospital/ Health-System 5,007 8% 92% 0 – 647 (0 – 84%) Ambulatory Care 4,982 32% 68% -65 – 307 (-30 – 88%) Inpatient/ Acute Care 6,646 30% 70% 0 – 443 (0 – 84%) Required APPE %Precepted Excess/(Deficit) by Adjunct Rotation Range Faculty by Program *Existing or new schools about to produce graduates Experiential Education Standards – Evaluation Since S2007 (N=49 programs) S2007 Standard Compliant Compliant w/ Monitoring Partially Compliant NonCompliant Standard 14. Curricular Core—Pharmacy Practice Experiences 14 25 8 2 Standard 28. Practice Facilities 29 17 2 1 Dean-Submitted Questions Quality/Quantity – Manpower • Will ACPE extend scope to include applicant schools’ assessment of manpower, need, quality of applicant pool, impact on clinical and other resources? • Discuss ACPE position on the oversupply of pharmacists in certain parts of the country. • Please project anticipated changes in supply within the next 5 years with proliferation of schools. Dean-Submitted Questions Quality/Quantity – Manpower • Please discuss ACPE's interpretation (or use) of the Pharmacist Demand Survey (ADI) by Kathy Knapp – Does ACPE utilize this survey to help determine if a new schools application is appropriate? Manpower Issues Cannot Be Considered in Accreditation • Accreditation is designed to advance quality – not restrict the market • Sherman Antitrust Act of 1890 prohibits restraint of competition • PharmD is a nationally recruited applicant pool with national employment opportunities Accreditation and Competition • Accreditation decisions may affect the marketplace • Accreditation decisions are based strictly on compliance with the standards – Cannot consider the effect on the marketplace • Consideration of the effect on the marketplace in making accreditation decisions could subject ACPE to prosecution under antitrust laws and, potentially, jeopardize ACPE’s recognition by the U.S. DOE Do the accrediting bodies for other health professions dictate the quantity of schools or numbers of graduates? Growth Trends in Education Among Other Health Professions Accredited Programs 2000 Accredited Programs Plus Applications (Net % Change) 2011 Medicine (LCME) 125 141 (+13%) Osteopathy (AOA-COCC) 19 28 (+47%) DNP = 0 (new degree) 58 Physical Therapy (APTA) 196 229 (+17%) Occupational Therapy (OTA) 131 154 (+18%) Dentistry (ADA CODA) 55 60 (+9%) Health Profession/ Accreditor Nursing (CCNE) Dean-Submitted Question Quality in Accelerated PharmD Programs • Has ACPE discussed a national unified curriculum such that some programs with accelerated programs are not allowed to “degrade pharmacy education?” – "Five-year PharmD" in some new schools – Curriculum structuring accelerates the professional and pre-professional years: morphing of 5 year BS into 4 year PharmD NAPLEX Passing Rate for First-Time Candidates 2008 – 2010 Three-Year vs. Four-Year Programs 96.9% 99% 96.2% 95.7% 96.7% 94.4% n = 90 n = 85 n=8 84% n = 83 89% n=7 94% n=8 93.9% Three-Year Programs 79% Four-Year Programs 74% 69% 2008 2009 2010 Dean-Submitted Questions Questions About Finances • Please discuss how ACPE's financial resources are made transparent to the public. • Please summarize the revenues derived from schools and elsewhere and summarize major categories of expenses. – Schools are belt-tightening. What about ACPE? • Are there ways to reduce accreditation expenses? Dean-Submitted Questions Questions About Finances • ACPE has "recommended" that some programs add personnel (increasing school’s expenses without generating additional funding). Is ACPE sensitive to the critical financial standing of some institutions secondary to state budget cuts and unfunded mandates? • Discuss the issue of a dues increase. Is this on the horizon? Summary of Discussion • ACPE is committed to assuring quality in pharmacy education and encouraging innovation • ACPE wants to continue to engage in a collaborative dialogue • ACPE is committed to working with the profession to ensure standards and guidelines are reflective of emerging evidence and practice needs Summary of Discussion • Expansion in the number of pharmacy school graduates is a result of growth in both existing and new programs • Marketplace effects cannot be considered in accreditation decisions • Accreditation decisions are based strictly on compliance with the standards • ACPE is focused on careful use of resources and ensuring good stewardship of Council funds “A coach is someone who can give correction without causing resentment.” ―John Wooden ACPE’s desire is to be a coach to colleges and schools of pharmacy